|
MRI Wrist w/ Contrast Left
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
1169134
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.25 |
| Max. Negotiated Rate |
$1,116.05 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$591.22
|
| Rate for Payer: Amerigroup Medicare |
$465.86
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$461.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$585.48
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$461.25
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$594.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$530.44
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Wrist w/ Contrast Left
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222 LT
|
| Hospital Charge Code |
1169134
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Wrist w/ Contrast Right
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
1169136
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.25 |
| Max. Negotiated Rate |
$1,116.05 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$591.22
|
| Rate for Payer: Amerigroup Medicare |
$465.86
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$461.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$585.48
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$461.25
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$594.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$530.44
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Wrist w/ Contrast Right
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73222 RT
|
| Hospital Charge Code |
1169136
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Wrist w/o Contrast Left
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
1169140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$459.45 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Aetna of IA Medicare |
$581.97
|
| Rate for Payer: Amerigroup Medicaid |
$588.91
|
| Rate for Payer: Amerigroup Medicare |
$464.04
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$459.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$583.20
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$459.45
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$591.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$528.37
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI Wrist w/o Contrast Left
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73221 LT
|
| Hospital Charge Code |
1169140
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$714.70 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
|
|
MRI Wrist w/o Contrast Right
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
1169142
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$459.45 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Aetna of IA Medicare |
$581.97
|
| Rate for Payer: Amerigroup Medicaid |
$588.91
|
| Rate for Payer: Amerigroup Medicare |
$464.04
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$459.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$583.20
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$459.45
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$591.77
|
| Rate for Payer: Partners Health Alliance Commercial |
$528.37
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$602.39
|
| Rate for Payer: Wellmark IA HMO WHPI |
$724.60
|
| Rate for Payer: Wellmark IA PPO |
$798.18
|
|
|
MRI Wrist w/o Contrast Right
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
CPT 73221 RT
|
| Hospital Charge Code |
1169142
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$714.70 |
| Max. Negotiated Rate |
$918.90 |
| Rate for Payer: Aetna of IA Commercial |
$918.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$918.90
|
| Rate for Payer: Cash Price |
$816.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$765.75
|
| Rate for Payer: Medical Associates Commercial |
$765.75
|
| Rate for Payer: Midlands Choice Commercial |
$714.70
|
| Rate for Payer: United Healthcare Commercial |
$918.90
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
1169128
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.25 |
| Max. Negotiated Rate |
$1,116.05 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$591.22
|
| Rate for Payer: Amerigroup Medicare |
$465.86
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$461.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$585.48
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$461.25
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$594.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$530.44
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRI Wrist w/ + w/o Contrast Left
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73223 LT
|
| Hospital Charge Code |
1169128
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
|
IP
|
$1,025.00
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
1169130
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$717.50 |
| Max. Negotiated Rate |
$922.50 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
|
|
MRI Wrist w/ + w/o Contrast Right
|
Facility
|
OP
|
$1,025.00
|
|
|
Service Code
|
CPT 73223 RT
|
| Hospital Charge Code |
1169130
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$461.25 |
| Max. Negotiated Rate |
$1,116.05 |
| Rate for Payer: Aetna of IA Commercial |
$922.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$922.50
|
| Rate for Payer: Aetna of IA Medicare |
$584.25
|
| Rate for Payer: Amerigroup Medicaid |
$591.22
|
| Rate for Payer: Amerigroup Medicare |
$465.86
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Cash Price |
$820.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$768.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$461.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$585.48
|
| Rate for Payer: Medical Associates Commercial |
$768.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$461.25
|
| Rate for Payer: Midlands Choice Commercial |
$717.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$594.09
|
| Rate for Payer: Partners Health Alliance Commercial |
$530.44
|
| Rate for Payer: United Healthcare Commercial |
$922.50
|
| Rate for Payer: United Healthcare Managed Medicare |
$604.75
|
| Rate for Payer: Wellmark IA HMO WHPI |
$1,013.16
|
| Rate for Payer: Wellmark IA PPO |
$1,116.05
|
|
|
MRSA SCREENING
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
4022875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
|
|
MRSA SCREENING
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
4022875
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: Aetna of IA Commercial |
$50.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$50.40
|
| Rate for Payer: Aetna of IA Medicare |
$31.92
|
| Rate for Payer: Amerigroup Medicaid |
$32.30
|
| Rate for Payer: Amerigroup Medicare |
$25.45
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.20
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$31.99
|
| Rate for Payer: Medical Associates Commercial |
$42.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.20
|
| Rate for Payer: Midlands Choice Commercial |
$39.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$32.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$28.98
|
| Rate for Payer: United Healthcare Commercial |
$50.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.04
|
| Rate for Payer: Wellmark IA HMO WHPI |
$34.03
|
| Rate for Payer: Wellmark IA PPO |
$37.49
|
|
|
MULTIPLE PATIENT TRANSPORT
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS A0999 QN
|
| Hospital Charge Code |
7932765
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$139.50 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of IA Commercial |
$279.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$279.00
|
| Rate for Payer: Aetna of IA Medicare |
$176.70
|
| Rate for Payer: Amerigroup Medicaid |
$178.81
|
| Rate for Payer: Amerigroup Medicare |
$140.90
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$232.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$139.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$177.07
|
| Rate for Payer: Medical Associates Commercial |
$232.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$139.50
|
| Rate for Payer: Midlands Choice Commercial |
$217.00
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$179.68
|
| Rate for Payer: Partners Health Alliance Commercial |
$160.42
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$263.50
|
|
|
MULTIPLE PATIENT TRANSPORT
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS A0999 QN
|
| Hospital Charge Code |
7932765
|
|
Hospital Revenue Code
|
540
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna of IA Commercial |
$279.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$279.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$232.50
|
| Rate for Payer: Medical Associates Commercial |
$232.50
|
| Rate for Payer: Midlands Choice Commercial |
$217.00
|
| Rate for Payer: United Healthcare Commercial |
$279.00
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC
|
Facility
|
IP
|
$12,600.81
|
|
|
Service Code
|
MSDRG 059
|
| Min. Negotiated Rate |
$12,418.18 |
| Max. Negotiated Rate |
$12,600.81 |
| Rate for Payer: Amerigroup Medicaid |
$12,539.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$12,418.18
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$12,600.81
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC
|
Facility
|
IP
|
$19,559.35
|
|
|
Service Code
|
MSDRG 058
|
| Min. Negotiated Rate |
$19,275.87 |
| Max. Negotiated Rate |
$19,559.35 |
| Rate for Payer: Amerigroup Medicaid |
$19,464.85
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19,275.87
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19,559.35
|
|
|
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC
|
Facility
|
IP
|
$8,450.46
|
|
|
Service Code
|
MSDRG 060
|
| Min. Negotiated Rate |
$8,327.98 |
| Max. Negotiated Rate |
$8,450.46 |
| Rate for Payer: Amerigroup Medicaid |
$8,409.63
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$8,327.98
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$8,450.46
|
|
|
Multiple Vitamins IV Sol 10 mL[VDMC]
|
Facility
|
IP
|
$76.60
|
|
|
Service Code
|
NDC 54643-5649-01
|
| Hospital Charge Code |
10407586
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$53.62 |
| Max. Negotiated Rate |
$68.94 |
| Rate for Payer: Aetna of IA Commercial |
$68.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.94
|
| Rate for Payer: Cash Price |
$61.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.45
|
| Rate for Payer: Medical Associates Commercial |
$57.45
|
| Rate for Payer: Midlands Choice Commercial |
$53.62
|
| Rate for Payer: United Healthcare Commercial |
$68.94
|
|
|
Multiple Vitamins IV Sol 10 mL[VDMC]
|
Facility
|
OP
|
$76.60
|
|
|
Service Code
|
NDC 54643-5649-01
|
| Hospital Charge Code |
10407586
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$34.47 |
| Max. Negotiated Rate |
$68.94 |
| Rate for Payer: Aetna of IA Commercial |
$68.94
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$68.94
|
| Rate for Payer: Aetna of IA Medicare |
$43.66
|
| Rate for Payer: Amerigroup Medicaid |
$44.18
|
| Rate for Payer: Amerigroup Medicare |
$34.81
|
| Rate for Payer: Cash Price |
$61.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$57.45
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$34.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$43.75
|
| Rate for Payer: Medical Associates Commercial |
$57.45
|
| Rate for Payer: Medical Associates Managed Medicare |
$34.47
|
| Rate for Payer: Midlands Choice Commercial |
$53.62
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$44.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$39.64
|
| Rate for Payer: United Healthcare Commercial |
$68.94
|
| Rate for Payer: United Healthcare Managed Medicare |
$45.19
|
|
|
Multiple Vitamins with Minerals Oral Liq 236 mL [VDMC]
|
Facility
|
OP
|
$24.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$11.16 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna of IA Commercial |
$22.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.32
|
| Rate for Payer: Aetna of IA Medicare |
$14.13
|
| Rate for Payer: Amerigroup Medicaid |
$14.30
|
| Rate for Payer: Amerigroup Medicare |
$11.27
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.60
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$11.16
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$14.16
|
| Rate for Payer: Medical Associates Commercial |
$18.60
|
| Rate for Payer: Medical Associates Managed Medicare |
$11.16
|
| Rate for Payer: Midlands Choice Commercial |
$17.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$14.37
|
| Rate for Payer: Partners Health Alliance Commercial |
$12.83
|
| Rate for Payer: United Healthcare Commercial |
$22.32
|
| Rate for Payer: United Healthcare Managed Medicare |
$14.63
|
|
|
Multiple Vitamins with Minerals Oral Liq 236 mL [VDMC]
|
Facility
|
IP
|
$24.80
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10407653
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$22.32 |
| Rate for Payer: Aetna of IA Commercial |
$22.32
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$22.32
|
| Rate for Payer: Cash Price |
$19.84
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$18.60
|
| Rate for Payer: Medical Associates Commercial |
$18.60
|
| Rate for Payer: Midlands Choice Commercial |
$17.36
|
| Rate for Payer: United Healthcare Commercial |
$22.32
|
|
|
multivitamin Vitamin B Complex with C and Folic Acid Tab[VDMC]
|
Facility
|
OP
|
$1.46
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
28562975
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Aetna of IA Medicare |
$0.83
|
| Rate for Payer: Amerigroup Medicaid |
$0.84
|
| Rate for Payer: Amerigroup Medicare |
$0.66
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.66
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.66
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.76
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.86
|
|
|
multivitamin Vitamin B Complex with C and Folic Acid Tab[VDMC]
|
Facility
|
IP
|
$1.46
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
28562975
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna of IA Commercial |
$1.31
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.31
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.10
|
| Rate for Payer: Medical Associates Commercial |
$1.10
|
| Rate for Payer: Midlands Choice Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
|
